Chairman

Institute of Minimal Access, Metabolic & Bariatric Surgery (iMAS) Sir Ganga Ram Hospital | New Delhi

Medical Director

Bhatia Global Hospital & Endosurgery InstitutePaschim Vihar | New Delhi
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Media & Press Coverage

Surgery on the rise for obese teens. 25-Aug-2013 \"If the child is showing comorbidities like diabetes and hypertension, has reached puberty and achieved certain growth milestones then surgery can be an option.\" says Dr. Bhatia, who operated on 10 children last year.
Obesity prompts more cases of bariatric surgeries. 28-Jul-2013 \"By 2020 we will become the diabetic capital of the world. Its alarming.\" says Dr. Parveen Bhatia, Chairman of iMAS at Sir Ganga Ram Hospital. Bhatia now performs over 25 bariatric surgeries every month at the hospital.

Patient Testimonials

 

Understanding Hairfall post Weight Loss surgery

   UNDERSTANDING HAIRFALL POST WEIGHT LOSS SURGERY (WLS)
                                                                                                                                              -  by Lifestyle & weight management consultant
                                                                                                                                          Dt. Neetu bajaj (Bariatric Dietitian) 
 
One of the common concern & fear amongst most people who are considering bariatric surgery (weight loss surgery) or have undergone it , is post surgery hair fall. 
We all want to achieve great weight loss results but don’t want to lose hair. Before understanding the underlying nutritional & surgical cause for the type of hair fall associated with any WLS (weight loss surgery), & also how to alleviate it, we all in general need to know a little about the human hair growth cycle .
 
                                                                                                              THE HAIR GROWTH CYCLE
For most of our life, we all are always in the process of both growing & losing hair. Typically at any given time in human growth phase, about 90% of hair follicles are in growth phase (also known as anagen phase) and only 10% of hair follicles are in resting or dormant phase (also known as  telogen phase). That means you are losing a lot less hair strands than you are growing, so you don’t have a noticeable hair loss. 
 
Effects of psychological, environmental, emotional or surgical stress on hair growth cycle 
Sometimes under specific types of stressful circumstances like high fever, severe infection, chronic diseases such as cancer, major surgeries or any type of physical or emotional trauma causes a temporarily shift of a much greater percentage of hair follicles into the resting phase or telogen phase from the growth phase or anagen phase. And the hair follicles in the telogen phase shed their hair strands more easily. This type of diffuse hair loss is called telogen -effluvium. So some hair fall is expected after any Weight Loss surgery, but we don’t need to panic or fret as this is only a temporary phase & can be resolved soon by maintaining a proper well planned high protein post surgical diet along with the supplementation of specific multivitamin & minerals as advised by your bariatric dietitian & surgeon.
 
How to Minimize hair loss post Weight Loss surgery
 
Hairloss post Obesity surgery / Weight loss surgery is also known as Telogen-effluvium is a temporary phase and will not last for more then 4-6 months post surgery. One of the biggest reason we tends to lose hair post surgery is the lack of nutrients received by our hair follicles, as the human body is smart enough to shift all the nutritional reserves towards maintaining the normal functioning of the much vital organs like your kidney, brain, heart & liver as they perform major life sustaining activities away from your hair, nails &skin,  the secondary organs to be supplied with required nutrients especially at the time of reduced calorie ,nutritionally compromised & low protein  diet post WLS. Hence it is really very essential to stay focused towards adapting & practicing a modified & nutritionally dense meal  post WLS to minimize the hairfall.
 
ROLE OF VARIOUS MACRO AND MICRO NUTRIENTS FOR HEALTHY HAIR GROWTH 
                                                                                                                          Protein 
I have stressed several times about the importance of protein in a post bariatric surgery diet in my previous blog  PROTEIN FIRST and also in my book  Healthy eating post bariatric surgery. It is the only macronutrient that will not only help you to maintain your lean body muscle mass & to boost your sluggish metabolism but it is also a very vital nutrient in maintaining the health of your hair, skin & nails too. As hair is predominantly composed KERATIN, a type of protein and a diet lacking in protein can effect hair growth cycle .Post WLS I always advice to people to fulfill their daily protein requirements by consuming protein rich shakes & whey protein powders mixed in your smoothies or shakes at least twice a day, as it is hard to get your protein RDA (recommended dietary allowance) fulfilled by relying only  on  dietary sources of protein due to reduced calorie intake & other restrictions also.
 If you are not consuming enough protein, as advised by your bariatric dietitian in your post surgical diet or having too little of it then you may experience hair fall. As per ACMBS the RDA for women post surgery is 50-60 gram per day and RDA for men is 60-80 gram per day.
 
Your best sources of protein are:
Animal sources: eggs, chicken, lean cuts of meat, turkey, sea food like fish, oysters, shrimps & lobsters etc., skimmed or low fat milk and its products like cottage cheese, curd or buttermilk. 
Plant sources:
All types of pulses and lentils like rajma, channa and lobiya etc.
Soy and its products like soy milk, tofu and soy beans. 
Nuts and seeds like almonds, walnuts, sunflower seeds, pumpkin seeds etc
Whole Grains like amaranth, quinoa, millets and oats etc.
 
(Refer page no 24, 25 & 36 of my book HEALTHY EATING POST BARIATRIC (WEIGHT LOSS) SURGERY for the amount of protein per serving in different protein rich food groups. And also refer my previous article PROTEIN FIRST for further in-depth information for the macronutrient’s importance in a post surgical diet) 
                                                                                                           
                                                                                                                   Iron 
Iron is  a vital mineral required in formation of red blood cells (RBCs) that supply oxygen from lungs to different parts in the body. Its deficiency in blood disrupts the supply of essential mineral not only to distal organs in your body but also to hair follicles which affects the normal hair growth  which eventually leads to hair fall.  Reduced RBC count or low levels of hemoglobin (Hb) due to lack of serum iron in the blood is classified as iron deficiency anemia. Premenopausal women are particularly more susceptible to it because of monthly blood loss & sometimes during pregnancy too. Though post any type of WLS both men & women are equally more likely to experience iron deficiency anemia due to dietary intake restrictions or sometimes due to malabsorption. 
One should always aim to get minimum of 18mg of daily iron supplement in addition to the various dietary sources of iron like:
Non vegetarian sources of iron are: red organ meat, eggs, oysters and clams etc.
Vegetarian sources of iron are: soybeans, chickpeas, kidney beans pomengranate, tomatoes, spinach, beetroot, prunes, wheat-grass, spirullina (fresh see-weed algae) and all types of nuts & seeds too.
 
                                                                                                                 Vitamin C 
I always advocate taking iron supplements or iron rich meals in combination with the vitamin C rich food or its supplement as the mighty vitamin C supports iron absorption. It also aids in production of collagen that strengthens capillaries thus improving the supply of nutrients to hair shafts & skin too.
Food you should eat to boost your vitamin C intake includes spinach, bell peppers, lemon juice, oranges, kiwifruit, papaya and broccoli etc.  
3. Vitamins from vitamin B group especially vitamin B-12 & vitamin B-7:
The vitamins from the vitamin B-complex group helps not only for proper nerve functioning, cellular metabolism for the conversion of food you eat into energy required by the body to perform various life sustaining activities but also required to generate healthy looking hair, nails & skin especially vitamin B-7 & vitamin B-12.
You should always aim to get 1000mcg of vitamin B12 (METHYCOBALAMINE) & 2500-5000 mcg of vitamin B-7 (BIOTIN) per day either separately or in your daily post surgical multivitamin pill as advised by your surgeon or bariatric dietitian. 
Various dietary sources of vitamin B-12 &B-7 are:
Non vegetarian sources are: red meat, eggs & all types of a sea food etc.
Vegetarian sources are: milk & its products like curd & cheese etc, various nuts & seeds, all types of lentils & pulses, fruits like bananas, strawberries, raspberries, oranges, avocado, & sea weed like spirullina etc.
 
                                                                                                                    Vitamin D
It is also known as the sunshine vitamin as exposure to early sunrays promotes its synthesis. Vitamin D not only promotes the absorption of calcium important for maintaining bone strength, helping the heart pump correctly and repairing soft tissues  but it also promotes a healthy follicle growth. Though nowadays more than 80% of Asian population is deficit in this sunshine vitamin & if your blood investigations reflects vitamin-D deficiency then it is highly recommended to start with it’s supplementation as advised by your surgeon . You should always aim to have daily 2000 IU of it in tablet/sachet/syrup form, if you are not taking a weekly mega dose of 50K IU-60K IU.
In addition of it you should consume food that is rich in vitamin-D like fatty fish, organ meat, milk & its products, fortified cereals, pulses & grains etc. 
 
 
                                                                                                                      Zinc & Selenium
These are the two more important minerals that you should befriend with for the sake of your locks. These two micronutrients are involved in various processes related to hair cycle including cellular metabolism &protein synthesis too. Zinc deficiency is associated with telogen effluvium, and thinning of hair. It also regulates the signaling pathway that controls the transition of hair follicles from anagen to telogen and vice-versa.
And zinc deficiency post bariatric surgery due to gastrointestinal changes & calorie restricted diet is one of the major concern factors that can also be related with telogen effluvium. 
Nuts, red meat, fish, oysters & eggs are amongst the good dietary sources for zinc & selenium. But vegetarians can also get them from nuts, pumpkin seeds, sunflower seeds, hemp seeds & chia seeds . Or else, other than getting them through dietary sources and if you are deficit in, can also get them in combination with iron & folic acid salt in various supplements form. You can get it prescribed from your surgeon or bariatric nutritionist.
  
                                                                                   Essential fatty acids (omega -3 & omega -6 fatty acids) 
These are called Essential Fatty Acids, as they can’t be internally synthesized or human body can’t produce them & thus they are required to be consumed through diet in the recommended amount.  
Linoleic acid (LA) & Alpha Linoleic Acid (ALA) belong to the omega-6 &omega -3 fatty acids groups respectively and are considered vital for maintaining the integrity of not only your hair, nails & skin but also they are vital for the smooth functioning of  nervous system. Its deficiency has been associated with skin lesions, brittle hairs & skin and also with hair fall. 
Various types of nuts, Flaxseeds , olives ,avacadoes & hempseeds are considered as good source to get ALA other than non vegetarian dietary source like fish.
 
TO SUM UP :
  • Hair fall post WLS is a temporary & manageable phase 
  • It may be cause of timely emotional, physical, environmental stressors of surgery which is again a temporary phase & can be taken care of with proper post surgical high protein &nutritionally dense diet.
  • Carefully monitor your protein intake daily
  • Be regular in getting your periodical blood investigations done to acess any nutritional deficiency.
  • Include post surgical essential multi vitamins & mineral supplementation as you have been advised for by your surgeon in your daily action plan other then diet & hydration.
  • Last but not least ,ensuring adequate nutrition by adhering to an appropriate post bariatric surgery diet plan ,as prescribed by your bariatric dietitian along with supplement regimen will reduce the risk of hair loss & will also support your overall wellbeing.